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Fred Ushakov – Teaching

Written by London Pregnancy Clinic on . Posted in Blog.

One of Dr Fred Ushakov’s passions is teaching and training other professionals in the field of Fetal Medicine and the applications of ultrasound screening. Prior to the pandemic Fred lectured in countries such as the US, Australia, Italy, Sweden, Peru, Egypt, Romania, Ukraine and China, where the picture below was taken. Fred has also collaborated with GE Healthcare in live masterclass demonstrations in their Brussels HQ.

During the pandemic, Dr Ushakov was one of the pioneers to start broadcasting his lectures online. His lectures are mainly focused around his field of interest of early anomaly detection and the Early Fetal Scan. In the past year alone, over a thousand ultrasound professionals have attended his courses online.

Happy Easter From City Ultrasound!

Written by London Pregnancy Clinic on . Posted in Blog.

City Ultrasound London is wishing you a very Happy Easter!

This is a tiny present from us, enjoy this 4D scan image of a fetus at 12w + 3d when it’s 5.4cm long in its little egg- the amniotic sac.

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8 Week Scan in 3D

Written by London Pregnancy Clinic on . Posted in Blog.

3D at 8 weeks?! ???

We always like to test the capabilities of the latest ultrasound tech. This is a real 3D image of an embryo at just 8 weeks when it is typically just 3/4 of an inch long (just short of 2cm – the size of a raspberry.)

By 8 weeks the embryo will already have tiny hands and feet as well as distinguishable fingers and toes. The respiratory system is also starting to develop at this stage and the heart is beating at a rapid rate of 150-170 beats per minute to help facilitate the exponential growth of the embryo early in the pregnancy.

The baby’s structures are too small at 8 weeks to be able to properly examine them using ultrasound. NIPT (Harmony Test) is also not reliable at this stage due to the small fetal fraction in the mother’s blood – you will have to wait until at least 10 weeks.

That’s why at 6-9 weeks we recommend coming in for a Viability Scan:

  •  Confirm the baby’s heartbeat
  •  Date the pregnancy
  •  Check for single/multiple pregnancy
  •  Check main structures of the gestational sac, which include the baby (the embryo), the yolk sac, and the future placenta

Cerebellum

Written by London Pregnancy Clinic on . Posted in Blog.

Incredible shot of the Cerebellum at just 11 weeks in our recent instagram post!

This fetus is just 4cm long, but our advanced transvaginal probes are able to get this high resolution image of the cerebellum. Latin for ‘little brain’, the cerebellum is an important structure at the back of the human skull. The cerebellum is responsible for coordinating our voluntary movements, as well as motor skills, balance, coordination and posture.

It consists of two major structures namely the Cerebellar cortex and Cerebellar nuclei. Despite only being 10% of the human brain, the ‘little brain’ contains up to 80% of the brain’s neurons, mainly in the cortex. Neurons are important cells in the human body that are the building blocks of the nervous system.

You can see why it is important to check the development of the brain. Dr Fred Ushakov is a specialist in neurosonography and conducts a comprehensive examination of the brain with every scan from 11 weeks until the 3rd trimester.

The Umbilical Cord

Written by London Pregnancy Clinic on . Posted in Blog.

The Umbilical Cord is an important structure, it is essentially a tube that connects the baby and the placenta. The tube usually starts developing from 5 weeks of gestation and grows until the beginning of the third trimester at ~28 weeks.

The umbilical cord consists of 3 blood lines; 2 arteries and 1 vein and basically acts as a supply line between the placenta and the baby. You can see why it is an extremely important structure as it delivers nutrients and oxygen to the baby and removes the baby’s “waste” materials.

The cord can grow up to 80cm, but the average is ~55cm, a longer cord can be associated with entanglement and possibly some complications during labour. Some potential complications in the pregnancy are related to the umbilical cord, such as Vasa Previa. The umbilical cord is cut at birth and the residual usually dries and falls off within 2-3 weeks.

In the video attached you can clearly see the umbilical cord attached from the placenta to the baby at just 12 weeks of gestation!

At City Ultrasound, the umbilical cord is just one of the important structures we check at any scan from 12 weeks. On our website, we have in-depth information about our process and types of scans, but if you do have any questions at all, please feel free to get in touch with us!

We Are Moving!

Written by London Pregnancy Clinic on . Posted in Blog.

Dear Valued Patient, 

We have some exciting news to share with you! We have moved to the following address which is in close proximity to our old clinic:

36 Spital Square, London E1 6DY

City Ultrasound is pleased to announce a long awaited relocation to Spital Square, just a few minutes’ walk from the iconic Spitalfields Market and adjacent to the famous Galvin La Chapelle restaurant. We are proud to be able to offer our patients a fantastic new clinic equipped with the latest ultrasound technology, a spacious and light waiting room and much more (sneak peek photos attached!)

The relocation is effective immediately, and we have closed our Finsbury Circus clinic permanently. The new location is conveniently located within 3 minutes’ walk from Liverpool Street Station. Additionally, paid street parking is available in front of our new building.

I would like to take this opportunity to thank you, our valued patients, for supporting our newly established service. When opening our doors for our first patient in April 2020, it took us almost a year to prepare for the launch. It has been a long and challenging journey but we would not have been able to expand and get to where we are now without your support.

Finally, if you would like to share your experience with City Ultrasound, I would really appreciate if you could kindly leave a comment on Google Reviews. We hope to see you at our new clinic soon!

Kind regards,

Dr Fred Ushakov & Team

Amniotic Sac

Written by London Pregnancy Clinic on . Posted in Blog.

In today’s video you can clearly see the baby resting in the Amniotic Sac at about 11 weeks and even see its brain!

The amniotic sac is a pair of membranes (basically a filter that lets some things pass but stops others) where the baby is developing. The inner membrane is known as amnion, while the outer membrane is known as chorion. The amnion is filled with a fluid suitably called amniotic fluid which transfers essential substances such as oxygen from the umbilical cord to the baby. The chorion contains the amnion and is part of the placenta.

During labour, the amniotic sac breaks resulting in the ‘water breaking’ when the baby is ready to come out. In some cases, the amniotic sac doesn’t break during labour and the baby is born in a transparent bubble, this is quite rare and only happens in 1 in 80,000 cases- known as en caul birth!

At City Ultrasound, the amniotic sac is just one of the important structures we check at any scan from 8 weeks. On our website, we have in-depth information about our process and types of scans, but if you do have any questions at all, please feel free to get in touch with us!

Transvaginal Scan (TVS)

Written by London Pregnancy Clinic on . Posted in Blog.

What is a transvaginal scan (TVS)?
“Transvaginal” means an internal examination through the vagina. TVS probes have extraordinary resolution and may provide unique information regarding the fetal anatomy, placenta, womb, cervix and other important structures.

Technically, examination by TVS during pregnancy is identical to gynaecological ultrasound. The special high-resolution probe is aseptically cleaned, covered with a sterile cover (like a condom) and sterile lubricating gel. The transducer inserted is no larger than a finger. It is gently passed into the vagina to generate images of the baby, while you lay on your back. This may cause some slight discomfort but should not cause any pain. It is important you let us know if you have a latex allergy, in which case we will use latex-free probe covers.

The operator performing the transvaginal scan in pregnancy must have a high level of expertise and experience. TVS scan represents a significant challenge for the doctor or sonographer because of difficulties in obtaining correct images. As such, there are only a few specialists in London performing transvaginal assessment of the early fetus, including Dr Ushakov.

Please empty your bladder immediately before the transvaginal scan. Even a small amount of urine in the bladder will change the position of the womb and will reduce the quality of image. A trained chaperone is also available and present for internal examinations and may be requested for any of our other scans.

Is TVS safe?
TVS uses the same safe ultrasound waves as transabdominal scans to obtain the images of the baby and womb. The probe cannot get into direct contact with the fetus. Normally, due to better resolution the time of TVS imaging is shorter in comparison to a transabdominal scan (approximately 10 minutes). We use rigorous aseptic technique for preparation of the probe and there is no risk of infection.

Visit our Instagram account for comparison of transvaginal (TVS) & transabdominal scans for the SAME pregnancy. Can you see how much better the resolution of the TVS scan (1st video)? This is generally the case for ultrasound scans up to 11weeks when the fetus is still very small, less than 1.6 inch!

Folic Acid

Written by London Pregnancy Clinic on . Posted in Blog.

What is folic acid? 

Folic acid is a synthetic (man-made) form of the Vitamin B-9 (folate), which naturally occurs in some foods such as asparagus, peas and broccoli. Folate supports generation of healthy new red blood cells, which carry oxygen around the body.  The deficiency of red blood cells may be conditions like anaemia, which often causes weakness and fatigue.  

Why is folic acid often recommended to women during their pregnancies? 

Prior to conception and within the first trimester (around week 12) it is often recommended that women take this artificial supplement to reduce the risk of a neural tube defects and ensure the healthy formation of red blood cells. Taking folic acid Folic acid also supports maternal tissue growth and increases maternal folate to reduce risk of neural tube defect. Can reduce the risk of developing neural tube defects by up to 70% (WHO, 2015).  

What is a neural tube defect? 

The neural tube is an embryonic structure that lays the foundation for the central nervous system (consisting of the brain and spinal cord). Neural tube formation begins just three weeks after conception, and proper formation is vital for brain development. Neural tube defects occur when the formation of the neural tube does not develop or form correctly. These may result from a lack of folic acid in the first 28 days of pregnancy, causing the neural tube to poorly develop. Typically, the neural tube closes in the 4th week following conception. Neural tube defects include birth defects of the skull and brain like acrania or encephalocele, spine and spinal cord, such as spina bifida.  

How much folic acid is recommended? 

It is recommended that those who are planning to get pregnant take 400 micrograms supplement daily (NICE, 2014) both prior to pregnancy and for the first 12 weeks. The NICE recommend taking this supplement regardless of whether you are eating folate-rich foods.   

Your GP may prescribe or recommend a higher dose if you have a BMI over 30, have diabetes, anaemia, sickle–cell disease, coeliac disease, take medication for epilepsy or have a history of neural tube defects.  

What foods contain folic acid? 

Asparagus, peas, broccoli, oranges, bananas. Green beans, kale, spinach, yeast extract and fortified cereals.  

Can you detect neural tube defects by ultrasound?

Yes – Dr Ushakov has been developing new methods for detecting these anomalies in the first trimester from as early as 10 weeks.  

For support for spina bifida and hydrocephaly: Shine Charity 

Sources: 

NICE (2014). Maternal and Child Nutrition [Online] [link] 

NICE (2021). Neural Tube Defects (Prevention in Pregnancy) [Online] [link] 

SHINE (2021). Folic Acid. [Online] [Link] 

Ushakov, F., Sacco, A., Andreeva, E., Tudorache, S., Everett, T., David, A.L & Pandya, P. P. (2019). Crash Sign: New First‐Trimester Sonographic Marker of Spina Bifida. [Online] [Link] 

World Health Organisation (2015). Prevention of Neural Tube Defects by The Fortification of Flour with Folic Acid: A Population-Based Retrospective Study in Brazil. [Online] [link]

COVID-19 Vaccine and Pregnancy

Written by London Pregnancy Clinic on . Posted in Blog, Covid-19.

We have collected some information and official guidance from the government and relevant professional bodies about the Covid-19 Vaccine, Your Pregnancy and Fertility:

RCOG – Royal College of Obstetricians and Gynaecologists

JCVI – Joint Committee on Vaccination and Immunisation

Who can have the vaccine?

Currently the vaccine has yet to be tested on pregnant women, and so the vaccine is not recommended to be provided routinely to all pregnant patients. At present, the Covid-19 vaccine is only being offered to the following groups of pregnant women who are at a higher risk of catching the virus:

  • Those working in the health and social care sectors.
  • Those considered clinically extremely vulnerable* (RCOG definition)

If you fall into one of these two categories, you may be offered the vaccine and have the choice to accept it or alternatively wait for more data to be published regarding its effects.

I am eligible for the vaccine – will it affect my baby?

The RCOG have previously reassured pregnant women that since the vaccine cannot replicate (unlike biological viruses) it cannot cause infection in the mother or baby.

I am breastfeeding – will the vaccine affect my baby?

The RCOG and JCVI have stated that there is no known risk associated with giving non-live vaccines such as the Covid-19 vaccine to breastfeeding patients. At present there is no data available on the effects of the vaccine on breastfeeding or the breastfed child. However, the JCVI recommend that you receive the vaccine whilst you are breastfeeding, based upon the vast benefits that breastfeeding provides for your growing child. If you have any concerns, you may decide to wait until you have completed breastfeeding before having the Covid-19 vaccine.

I have had my first dose of the vaccine but have become pregnant since, should I have the second dose?

The JCVI recommend that you delay your second dose until you have delivered your baby, unless you fall into the high-risk categories described above.

Can the Covid-19 vaccine affect fertility?

The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) have recently published a joint statement in response to misinformation spread about the Covid-19 vaccine’s effect on fertility. The RCOG and RCM state that there is no evidence to suggest that the vaccine may affect fertility. The RCOG President expands: ‘There is no biologically plausible mechanism by which current vaccines would cause any impact on women’s fertility.

Evidence has not been presented that women who have been vaccinated have gone on to have fertility problems.’ – Edward Morris, President of RCOG (2021) The RCM and JCVI recommend that you speak to your midwifery/primary healthcare team regarding any queries or worries you may have about the Covid-19 vaccine.

For more information on who may be eligible and further details on the above statements, please visit the referenced links below:   References: RCOG (2021). I am Pregnant and Have Been Offered a COVID-19 Vaccination. What are My Options? [Online] [Link]

RCOG (2021). The RCOG and the RCM Respond to Misinformation Around Covid-19 Vaccine and Fertility. [Online] [link]

RCOG (2020). Updated Advice on COVID-19 Vaccination in Pregnancy and Women who are Breastfeeding [Online] [link]

JCVI (2021). COVID-19 Vaccination: A Guide For Women of Childbearing Age, Pregnant or Breastfeeding [Online] [link]